Advances in Aortic Stenosis

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What Is Valve-in-Valve TAVR?

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Female doctor explaining reports on digital tablet to patient with nurse writing notes in background
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If you have aortic stenosis, the opening to your heart’s aortic valve is narrowed, making it harder for your heart to pump blood out to the rest of your body. Severe aortic stenosis treatment may require a procedure to replace the diseased valve with a new one. However, one type of replacement valve—called a tissue heart valve or bioprosthetic heart valve—can start to wear down after 10 to 15 years, creating the need for yet another valve replacement.

Until recently, open-heart surgery was needed to perform a second aortic valve replacement. Now studies are showing that a minimally invasive procedure known as valve-in-valve transcatheter aortic valve replacement (TAVR) may be an option for some patients instead.

Why do some tissue heart valves need to be replaced?

Tissue heart valves are made from flexible tissues taken from animals, such as pigs or cows. Their advantage is they don’t require you to be on blood thinners for the rest of your life, unlike with man-made mechanical heart valves. But over time, they can become scarred and stiff or fail to close properly, allowing blood to leak backwards into the heart.

The good news is patients who’ve had aortic valve replacements continue to live longer lives. But this means the need for an eventual second procedure increases as well.

My Aortic Stenosis Confession: Susan

How does valve-in-valve TAVR work?

A thin tube called a catheter is inserted into a blood vessel in your leg or a small incision in your chest. Using advanced medical imaging, the catheter is advanced into the area of the failed tissue valve, guiding a new, compressed tissue valve along with it. The new valve is then expanded over the old valve and begins to function in its place. Once it’s secure, the catheter is removed. Because this is a minimally invasive procedure, recovery is minimal and you could be back to your normal life in as quickly as a week.

So far, the results of valve-in-valve TAVR have been encouraging. One study compared the rates of death, stroke, heart attack and bleeding 30 days after the procedure and found valve-in-valve TAVR to have better short-term outcomes than surgical aortic valve replacement (SAVR) via open-heart surgery, a much more invasive procedure with a longer, more painful recovery time. There was no significant difference in long-term outcomes from either procedure.

Who is a candidate for valve-in-valve TAVR?

Currently, valve-in-valve TAVR is approved for individuals at high-risk of serious complications from undergoing open-heart surgery, such as older patients or those with significant medical issues. More research is ongoing to determine if valve-in-valve TAVR is the preferred option for lower-risk and younger patients, but studies show promise.

If you’ve had a previous aortic valve replacement and think you may need another one, talk to your doctor about whether valve-in-valve TAVR is appropriate for you.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Mar 12
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Transcatheter Valve-in-Valve vs. Redo Surgical Aortic Valve Replacement. American College of Cardiology. https://www.acc.org/latest-in-cardiology/journal-scans/2020/07/28/13/08/transcatheter-valve-in-valve-aortic-valve#:~:text=This%20retrospective%2C%20administrative%20hospital%2Ddischarge,to%20redo%20SAVR%20for%20bioprosthetic
  2. Valve-in-Valve TAVR. University of Michigan Cardiovascular Center. https://www.umcvc.org/about-samuel-jean-frankel-cardiovascular-center
  3. Transcatheter Aortic Valve Replacement (TAVR). Mayo Clinic. https://www.mayoclinic.org/tests-procedures/transcatheter-aortic-valve-replacement/about/pac-20384698
  4. VIV TAVR or Repeat Aortic Valve Surgery? Research Shows More Randomized Trials Needed. American College of Cardiology. https://www.acc.org/latest-in-cardiology/articles/2020/07/27/15/21/viv-tavr-or-repeat-aortic-valve-surgery-research-shows-more-randomized-trials-needed
  5. Transcatheter Aortic Valve-in-Valve Procedure in Patients with Bioprosthetic Structural Valve Deterioration. Methodist DeBakey Cardiovascular Journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5935197/